Basic Information
| Provider Information | |||||||||
| NPI: | 1578767935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FABIAN CARBONELL MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4250 N MARINE DR | ||||||||
| Address2: | SUITE 236 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606131744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734040160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4250 N MARINE DR | ||||||||
| Address2: | SUITE 236 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606131744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734040160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CARBONELL | ||||||||
| AuthorizedOfficialFirstName: | FABIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7734040160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.